LAUSR

Objectives Cardiac injury has been reported in up to 20-30% of COVID-19 patients and severe disease can lead to cardiopulmonary failure. The role of mechanical circulatory support in these cases remains undetermined. We aimed to determine characteristics and outcomes of patients with COVID-19 requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO) or veno-arterial-venous (VAV) ECMO support. Design and Setting A multicenter, retrospective case series. Participants The cohort consisted of adult patients (18 years of age and older) with confirmed COVID-19 requiring VA- or VAV-ECMO support in the period from March 1, 2020 to April 30, 2021. Outcomes were recorded until July 31, 2021. Measurements and Main Results To show factors related to death during hospitalization, patients were grouped as survivors and non-survivors. Kaplan Meier analysis was used to estimate 90-day in-hospital mortality. Overall, 37 patients from 12 centers comprised the study cohort. Patients were 44 (IQR, 35-52) years old, 12 (32%) were female. Duration of ECMO support ranged from 2 to 132 days. At the end of the follow-up period, 13 patients (35%) were discharged or transferred alive, and 24 patients (65%) died during the hospitalization. The cumulative in-hospital mortality at 90-days was 64% (95% CI: 47-81). Time from intubation to VA- or VAV-ECMO initiation (1 IQR 0-7.5 vs. 6 IQR 2.5-14 days, p=0.0383), body mass index (32 IQR 26-36 vs. 37 IQR 33-40, p=0.009) and baseline C-reactive protein (7.15 vs. 38.9 mg/dL, p=0.009) were higher in those that expired. Conclusions Only one-third of the patients with COVID-19 requiring VA- or VAV-ECMO survived to discharge. Close monitoring of at-risk patients with early initiation of ECMO with circulatory support may further improve outcomes.